Thursday, April 20, 2006

The best laid plans

Keeping with the theme of excrement, which for some reason most of the comments on my last post focused on to the exclusion of all the other fascinating aspects of my Brussels trip: when I was an overworked, underpaid, put-upon, abused, tortured and entirely unselfpitying house officer (US: intern) in my first hospital post, one of the jobs we all dreaded was faecal disimpaction. This needed to be done when a severely constipated patient, usually elderly, could not pass stool with the help of even the most powerful laxatives and enemas. (As an aside, there’s a product used to irrigate the colon in preparation for bowel surgery which has the name ‘Golightly’. Let’s have more of this kind of humour when naming medicinal products.) What you did in extreme cases was shove a pipe called a flatus tube up the patient’s anus. Bowel gas would then come exploding forth and the force of this would expel much of the solid contents with it. The rest of the stool could then be removed manually.

Understandably this was not the most sought-after task, and responsibility for it would ping-pong back and forth between the nurses and the doctors. As house officers, we were the lowest rung on the ladder and usually ended up with the job, since the nurses would get out of it by pointing out that it was technically an invasive procedure and therefore one they were not permitted to carry out. Bullshit, of course, but I couldn’t blame them. One evening I was called upon to rise to the occasion. My heart leapt, for that week I was blessed with the presence of a medical student. Most of the time med students were a pain in the arse as they got under your feet when you were trying to do things and they made constant demands to be taught, for crying out loud. But they were extremely useful when something unpleasant needed doing because you could pull rank on them.

Dan (not his real name) was an enthusiastic young chap into whom all my sterling efforts to knock some cynicism had failed. I handed him the tube and watched his face, expecting to see the first flickers of what would inevitably become the doctor’s permanent expression of sourness. If anything, he beamed even more broadly, grasped the tube like a baton in a relay race (which is quite a pertinent comparison now that I think of it) and strode off to the patient’s bedside.

The problem with the procedure is that no matter how painstakingly you position yourself out of the way of the tube, the expulsive force always, always results in at least some spattering of your clothes, your skin or your hair. I watched Dan ask the patient to turn on her stomach, then position the bucket behind her on the floor (a token effort if ever there was one). What he did next, I wasn’t expecting. He moved round to the patient’s head and reached down across the length of her body, sliding the tube in by pulling its end towards him. The flatus escaped with a Krakatoa-like detonation, the shit shot several yards to spray against the cubicle curtain, and nary a fleck besmirched Dan.

And the patient promptly vomited, great gouts of green and khaki spew drenching Dan’s legs and crotch. He was too self-controlled to cry out but I noticed with satisfaction that his grin twitched a little. I fled outside, and stood near the entrance doubled over, gales of laughter wracking me.

Dan earned himself the sobriquet Rainbow that day, and as far as I know they still call him that.

I read the first paragraph and then stopped becasue I am eating a bacon sambo with brown sauce and white pepper. I might read the rest of it later, might not. So sorry about the lack of sympathy over the whole dentist thingy, you are quite correct.

Being a parasitologist, one is never far away from stool. I cut my teeth looking down microscopes at squashed shit samples, trying to identify the eggs of common parasites. Fortunately, my sense of smell is somewhat underdeveloped, which means I can put my nose quite close to a sample and not fall backwards. My fragrant spouse, on the other hand, cannot even bring herself to brush away toilet bowl klingons.

Back off man I'm a scientist.I realised that the tube was inserted past the "pace car", what I don't understand, is that if there is built up gas pressure, why does releasing that pressure force out the bockage? Simple physics would suggest the opposite.

Dr McCrumble: you obviously pressed too hard against the microscope if you ended up cutting your teeth.

Dr Maroon: I wish I could draw a diagram for you. Think of a dam whose wall springs a leak. The fluid bursts through the hole and takes the edges of the hole with it. Gradually the whole edifice crumbles as the hole gets bigger. Perhaps you're seeing the blockage as a single mass, when in fact it's usually less solid than that.

Sexy:Theres a reason for his absence. See, Foot was communing with a lady of the evening from a nearby town and was caught in the act of marinading her toes by a local constable who was himself interested in bedding the scruffy beauty.After offering to share his catch with the officer--an offer which was turned down on account of the officer not being interested in eating feet--foot was taken to jail where he currently is planning on making a move on his cellmate, a nice young man with healthy, strong feet.